81225

Gene analysis (cytochrome p450, family 2, subfamily c, polypeptide 19) common variants

Medicare pricing data for 135 providers across 23 states

🤖AI Overview

Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Gene analysis (cytochrome p450, family 2, subfamily c, polypeptide 19) common variants (HCPCS code 81225) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $285.11, but hospitals typically charge $483.02 — a 1.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$57.02

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $285.11, your out-of-pocket cost would be approximately $57.02. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$285.11
Average Hospital Charge
$483.02
Markup Ratio
1.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$483.02
Medicare Allowed$285.11
Medicare Payment$285.11

Hospitals charge 1.7x more than what Medicare allows for this procedure. Medicare actually pays $285.11 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Kentucky$286$3953130+0.1%
Louisiana$286$326337+0.1%
Michigan$286$431136+0.1%
Mississippi$286$424281+0.1%
Nevada$286$292127+0.1%
New Jersey$286$388131,996+0.1%
New York$286$583197+0.1%
Oklahoma$286$582244+0.1%
South Carolina$286$5832216+0.1%
Utah$286$583123+0.1%
Arizona$286$5083498+0.1%
Arkansas$286$583122+0.1%
California$286$669474+0.1%
Colorado$286$950232+0.1%
Connecticut$286$864143+0.1%
Florida$285$349242,670+0.1%
Ohio$285$68152,758+0.1%
Texas$285$540451,396+0.0%
Pennsylvania$284$3376887-0.3%
Indiana$282$333153-1.2%
Minnesota$279$613237-2.2%
Virginia$273$3642122-4.1%
Massachusetts$268$508315-6.0%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber